The Relationship between Right Duct Lymph Flow and Extravascular Lung Water in Dogs Given a-Naphthylthiourea MICHAEL B. PINE, P. MAYNARD BEACH, THOMAS S. COTrRELL, MnRED SCOLA, and GERARD M. TuRiNo From the Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, 10032, and the Department of Pathology, New York Medical College, Valhalla, New York 10595
A B S T R A C T The relationship between right duct lymph flow and extravascular lung water was studied in 3 normal dogs and 15 dogs with pulmonary edema induced by a-naphthylthiourea (ANTU). Right duct lymph was collected in a pouch created by ligating jugular, subclavian, and brachiocephalic veins. Extravascular lung water was measured in vivo by double indicator dilution and post-mortem by weighing lungs before and after drying. Cardiac output, pulmonary artery and pulmonary artery wedge pressures, and the concentration of protein and electrolytes in plasma and right duct lymph were determined. Eight lungs were examined by light and electron microscopy. There was a direct relationship between right duct lymph flow (RDLF in milliliters per hour per gram dry lung) and extravascular lung water (Qwl in milliliters per gram dry lung) which was best described by the equation RDLF = 0.75 - 0.26 Qwl + 0.03 (Qwl).' Dogs with severe ANTU-induced edema had extensive lung capillary endothelial destruction but only mild interstitial swelling and no visible damage to type I alveolar epithelial cells. Cardiac output, pulmonary artery and wedge pressures, and protein and electrolyte concentrations did not correlate with either extravascular water or right duct flow. Thus, in ANTU-induced pulmonary edema right duct This paper was presented in part at the 45th Scientific Session of the American Heart Association, 17 November 1972, Dallas, Tex. An abstract of part of this work was published in 1972. Circulation. 46(Suppl. 2): 55. Dr. Pine is the recipient of Special Fellowship 5 F03 HE48180 from the U. S. Public Health Service. Received for publication 4 October 1974 and in revised form 11 March 1976.
482
lymph flow was directly related to extravascular lung water with the highest flows occurring with severe edema. The absence of a rapid increase in lymph flow with small increases in extravascular water may be due to early sequestration of fluid in the alveolar space. Hemodynamic changes did not account for changes in lung water or lymph flow. The pulmonary interstitial factors relating increased extravascular water to lymph drainage remain to be determined.
INTRODUCTION In 1896 Starling related the accumulation and removal of water from the interstitial space to fluid movement across the capillary membrane (1). In his model, the rate of fluid movement across this membrane was determined by a permeability coefficient and interstitial and vascular hydrostatic -and osmotic pressures. Although this model explains the gross balance between intravascular and interstitial fluid, fine adjustments between these two compartments depend upon the flow of lymph from the interstitial space into the intravascular compartment. The lung has an extensive lymphatic network and, in the 30 years since the pioneering work of Warren and Drinker (2), the flow and composition of pulmonary lymph have been described in normal dogs and in dogs with various conditions associated with increased extravascular lung water (3-16). However, the factors which govern pulmonary lymph drainage are not fully understood. In the present experiments, the relationship between extravascular lung water and right duct lymph flow was examined in dogs with varying degrees of
The Journal of Clinical Investigation Volume 58 August 1976 -482-492
pulmonary edema induced by intravenous a-naphthylthiourea (ANTU).1 METHODS
LIGATED R EXTERNAL JUGULAR VEIN
CEPHALIC VEIN
LIGATED R INTERNAL JUGULAR VEIN
Right duct lymph was collected from 19 mongrel dogs ORIFICE OF R LYMPH DUCT weighing 15-26 kg. 16 of these dogs received intravenous injections of 0.25-0.75 ml/kg of a l1o solution of ANTU OVERSEWN ORIFICES OF SMALL VEINS in propylene glycol 20-24 h before the lymph collection POLYETHYLENE CANNULA LIGATED R BRACHIOCEPHALIC began. 3 dogs received no treatment before the study. All VEIN 19 dogs were anesthetized with intravenous sodium thiamylal and intubated with a cuffed endotracheal tube. The right 7 / /"'zL BRACHIOCEPHALIC VEIN femoral artery was cannulated. A Swan-Ganz flow-directed catheter was inserted into the right femoral vein and ad- LIGATED R AXILLARY SUPERIOR VENA CAVA VEIN vanced into the pulmonary artery. A slow infusion of normal saline was administered through the catheter. Addi- FIGURE 1 Preparation of a pouch to collect right duct tional intravenous sodium thiamylal was given as needed lymph. The pouch is open and small veins not previously to maintain active inner eye reflexes with outer eye reflexes are oversewn. When the pouch is closed, a cannula occasionally present. The lungs were inflated maximally with ligated an ambu bag, and 3-5 ml of a 0.5%o aqueous solution of T- will be sewn in place to drain the bloodless right duct lymph. 1824 was injected directly into the right lung via a 20-gauge needle inserted through the chest wall. The dogs were tube received blood for 1 s. I was counted on an Autopermitted to breathe room air spontaneously for the re- Gamma spectrometer (Packard Instrument Co., Downers Grove, Ill.), and 3H was counted on a Tri-Carb liquid scinmainder of the experiment. Right duct lymph was collected in a pouch constructed tillation spectrometer (model 3003, Packard Instrument by ligating the right internal and external jugular, axillary, Co.). Indicator dilution curves were derived for both indiand brachiocephalic veins as described by Leeds et al. (17) cators with recirculation corrected by linear extension of (See Fig. 1). Since lymph from this pouch was often con- the experimental curve on a semilogarithmic plot. Correction taminated with blood, -the pouch was opened and the orifices for the different water contents and pulmonary transit times of small veins still patent were oversewn with 5-0 cardio- of plasma and erythrocytes was made using the formula of vascular silk. The pouch was closed and a cannula sewn into Goresky et al. (19). The lymph collection was discontinued immediately after place. From three to six 20-min collections of bloodless lymph were completed in all dogs except one which appeared completion of the in vivo lung water determination. Each to be in respiratory distress with fulminant pulmonary dog was rapidly exsanguinated while its chest was opened, edema when the lymph collection was begun. In this single and pleural fluid, if present, was removed and measured. A animal, two 15-min lymph samples were completed before 15-ml sample of pleural fluid was stored for later analysis the animal expired. Samples were collected in test tubes con- in a test tube containing lithium heparin anticoagulant. The taining lithium heparin anticoagulant, and the volume of lungs were removed by cutting the main stem bronchi and each sample was measured with a 1-ml tuberculin syringe. the main pulmonary arteries and veins. The larger pulmoPulmonary artery, pulmonary artery wedge, and femoral nary arteries were dissected open, and gross blood was artery pressures were recorded on a multichannel electronic removed. Care was taken to avoid losing edema fluid from photographic recorder (model DR-8, Electronics for Medi- the bronchi. The lungs were weighed. A 300-500-mg section cine Inc., White Plains, N. Y.) using a Statham P23Db of lung was taken from the left upper lobe and also from transducer (Statham Instruments Div., Gould Inc., Oxnard, both the left and right lower lobes. The hemoglobin conCalif.). These pressures were obtained during the first tents of these three samples were used to estimate the intralymph collection period and approximately 10 min before vascular water remaining in the lungs by the method of the end of the final collection. At the time of each pressure Levine and Mellins (20). One lobe from each of eight dogs was prepared for light determination, blood was withdrawn from the pulmonary and femoral arteries and analyzed for Po2, Pco2, and pH and electron microscopical examination by injecting into on a Blood Gas Analyzer (Instrumentation Laboratory, the bronchus a solution of 2.5% glutaraldehyde in SorenInc., Lexington, Mass.). After the final measurement of sen's phosphate buffer at pH 7.6. The lobes were then suspulmonary arterial pressure, 20 ml of pulmonary artery pended in additional fixative. The fixed lung tissue was blood was removed for subsequent analysis and stored in minced, washed in phosphate buffer, osmicated, and emtest tubes containing lithium heparin anticoagulant. The bedded in Araldite (Ladd Research Industries, Inc., Burflow-directed catheter was then withdrawn until a right lington, Vt.). Thin sections were stained with lead citrate and uranyl acetate and were examined with a Siemens ventricular pressure was recorded. Immediately after the right-sided catheter was withdrawn Elmiskop 101 electron microscope (Siemens Corp., Iselin, into the right ventricle, extravascular lung water was mea- N. J.). Tissues from similar regions were processed for sured by the double indicator dilution technique of Chinard light microscopy and stained with hematoxylin and eosin. and Enns (18). II-Albumin was used as an intravascular Muscle, liver, and kidney sections were prepared and exindicator and [3H]water was the extravascular indicator. amined in a similar manner. Pulmonary artery blood sampled about 5 min before The indicators were injected into the right ventricle, and blood samples were collected from the right femoral artery death, pooled right duct lymph, and pleural fluid (if present) into heparinized test tubes on a rotating turntable. Each were centrifuged at 2,000 rpm for 30 min. In 10 experiments, the supernate was removed and analyzed for total 1Abbreviation used in this paper: ANTU, a-naphthyl- protein, sodium, potassium, carbon dioxide, and chloride. Total protein was measured by the biuret reaction, using thiourea.
Lung Lymph Flow in Dogs Given a-Naphthylthiourea
483
a blank to determine the base line for each sample (21). Electrolyte concentrations were determined using automated sequential analysis as described by Skeggs and Hochstrasser (22). The pulmonary artery hematocrit was measured by centrifuging duplicate samples in Wintrobe tubes at 2,000 rpm for 30 min. Postmortem extravascular lung water was measured by weighing both lungs immediately after death and suspending them in absolute alcohol for 24 h and in acetone for another 24 h. The lungs were then dried in an oven at 60°C for 72 h and weighed. Lobes suspended in glutaraldehyde were suspended in acetone for 24 h after small sections had been removed for microscopy. These lobes were then dried and weighed. Postmortem lung water was corrected for estimated intravascular water, and the dry weight of the lung was corrected for estimated residual hemoglobin content. Data were analyzed using statistical methods described in Snedecor and Cochran (23). A coefficient of variation of successive measurements of right duct lymph flow in single experiments was computed. Hemodynamic measurements and protein and electrolyte concentrations in dogs with and without pulmonary edema were compared using a t test for unpaired samples. The rates of lymph flow during the first and last collections in each animal were compared using a t test for paired samples. A linear regression comparing postmortem and in vivo measurements of extravascular lung water, and a linear and a quadratic regression comparing right duct lymph flow and postmortem extravascular lung water were fitted by the method of least squares. Correlation coefficients were calculated, and the conditional error test
discussed by Graybill (24) was used to test for significant improvement of the quadratic over the linear equation.
RESULTS Character of right duct lymph. In all 18 dogs reported in Table I, right duct lymph was clear and had a hematocrit of less than 1%o. Opalescent right duct lymph was obtained from one dog. Since opalescence is an indication of contamination with thoracic duct lymph, data from the dog with opalescent right duct lymph were not used in any subsequent analyses. Right duct lymph and lymphatics were blue in all dogs except two. In these two dogs, lymph became clear blue within 2 min after a second injection of T-1824 directly into the right lung. In the 18 dogs studied, the rate of lymph flow in successive collections of right duct lymph in each dog had a coefficient of variation of 13%. Furthermore, in these 18 experiments, there was no significant difference in the rate of lymph flow between the first and the final collection. Thus, lymph flow in each experiment remained relatively constant during the period of observation. Right duct lymph was successfully collected in 13 of the last 22 consecutive attempts (59%). Measurement of extravascular lung water. Extravascular lung water (Qwl) computed from wet weight,
TABLE I
Summary of Experimental Data* Mean BP
Wt
Qdl
Qwl
idQwl
flow
P1. Eff
kg
g
ml/g
mug
ml/hlg
ml
21 22 20
28.3 30.7 28.0
3.8 4.0 4.3
2.4 2.1 2.3
0.19 0.15 0.23
0 0 0
100 112 120
22 10 12
5 3 6
3.4 3.5 3.6 3.8 4.0 4.6 4.9
2.0 2.3 2.9 2.5 2.5 2.1 3.2 3.2 4.2 4.2 3.5 5.0
0.18 0.11 0.23 0.28 0.32 0.30 0.35 0.25 0.47 0.52 0.50 0.23 0.68 1.22 1.35
0 0 0 0 0 0 0 120 160 60 25 300 55 165 0
113 152 139
3 3 4
132 133
16 16 16 10 18 19
65
-
99
16 23 18 16 18 15 14 16
RDL
Dog no.
Qb
ml/kg
pa
Hct
SaO2
%
%
145 125 180
33 42 52
93 97 96
44 43 34 44 38 43 56 46
-
150 150 130 120 135 165 150 120 195
10 5 5 4 4 6
90 155 110 145 115 90
97 95 95 85 95 93 94 94 90 60 92 80 82 40 42
paw
fa
mm Hg
Controls 1 2 3
Pretreated with ANTU 4 5 6
7 8 9 10 11 12 13 14 15 16 17 18
18 22 16 16 22 21
17 20 17 19 15 16 16 26 20
29.8
37.8 27.0 22.9 33.9 26.7 24.4 31.4 28.0 26.0 23.4 25.6 25.6 44.5 37.0
5.1 6.0 6.9 7.1 7.6 8.0 9.3 10.1
97
226 135 110 107 96 149
-
5 6 -
4
52 51 51 75 52 73 72
* Qdl, dry lung weight; Qwl, extravascular lung water by weighing; idQwl, extravascular lung water by indicators; RDL, right duct lymph; PI. Eff, pleural effusion; Qb, cardiac output by '3'I-albumin; BP, blood pressure; pa, pulmonary artery; paw, pulmonary artery wedge; fa, femoral artery; Hct, hematocrit; SaO2, arterial oxygen saturation.
484
M. Pine, P. Beach, T. Cottrell, M. Scola, and G. Turino
0
5
O Antu -trea ted dogs * Normal dogs
o
0
4 o
3
° 0 O * idQwl * 0.23 + 0.56 Qwl r = 0.90 P
A B S T R A C T The relationship between right duct lymph flow and extravascular lung water was studied in 3 normal dogs and 15 dogs with pulmonary edema induced by a-naphthylthiourea (ANTU). Right duct lymph was collected in a pouch created by ligating jugular, subclavian, and brachiocephalic veins. Extravascular lung water was measured in vivo by double indicator dilution and post-mortem by weighing lungs before and after drying. Cardiac output, pulmonary artery and pulmonary artery wedge pressures, and the concentration of protein and electrolytes in plasma and right duct lymph were determined. Eight lungs were examined by light and electron microscopy. There was a direct relationship between right duct lymph flow (RDLF in milliliters per hour per gram dry lung) and extravascular lung water (Qwl in milliliters per gram dry lung) which was best described by the equation RDLF = 0.75 - 0.26 Qwl + 0.03 (Qwl).' Dogs with severe ANTU-induced edema had extensive lung capillary endothelial destruction but only mild interstitial swelling and no visible damage to type I alveolar epithelial cells. Cardiac output, pulmonary artery and wedge pressures, and protein and electrolyte concentrations did not correlate with either extravascular water or right duct flow. Thus, in ANTU-induced pulmonary edema right duct This paper was presented in part at the 45th Scientific Session of the American Heart Association, 17 November 1972, Dallas, Tex. An abstract of part of this work was published in 1972. Circulation. 46(Suppl. 2): 55. Dr. Pine is the recipient of Special Fellowship 5 F03 HE48180 from the U. S. Public Health Service. Received for publication 4 October 1974 and in revised form 11 March 1976.
482
lymph flow was directly related to extravascular lung water with the highest flows occurring with severe edema. The absence of a rapid increase in lymph flow with small increases in extravascular water may be due to early sequestration of fluid in the alveolar space. Hemodynamic changes did not account for changes in lung water or lymph flow. The pulmonary interstitial factors relating increased extravascular water to lymph drainage remain to be determined.
INTRODUCTION In 1896 Starling related the accumulation and removal of water from the interstitial space to fluid movement across the capillary membrane (1). In his model, the rate of fluid movement across this membrane was determined by a permeability coefficient and interstitial and vascular hydrostatic -and osmotic pressures. Although this model explains the gross balance between intravascular and interstitial fluid, fine adjustments between these two compartments depend upon the flow of lymph from the interstitial space into the intravascular compartment. The lung has an extensive lymphatic network and, in the 30 years since the pioneering work of Warren and Drinker (2), the flow and composition of pulmonary lymph have been described in normal dogs and in dogs with various conditions associated with increased extravascular lung water (3-16). However, the factors which govern pulmonary lymph drainage are not fully understood. In the present experiments, the relationship between extravascular lung water and right duct lymph flow was examined in dogs with varying degrees of
The Journal of Clinical Investigation Volume 58 August 1976 -482-492
pulmonary edema induced by intravenous a-naphthylthiourea (ANTU).1 METHODS
LIGATED R EXTERNAL JUGULAR VEIN
CEPHALIC VEIN
LIGATED R INTERNAL JUGULAR VEIN
Right duct lymph was collected from 19 mongrel dogs ORIFICE OF R LYMPH DUCT weighing 15-26 kg. 16 of these dogs received intravenous injections of 0.25-0.75 ml/kg of a l1o solution of ANTU OVERSEWN ORIFICES OF SMALL VEINS in propylene glycol 20-24 h before the lymph collection POLYETHYLENE CANNULA LIGATED R BRACHIOCEPHALIC began. 3 dogs received no treatment before the study. All VEIN 19 dogs were anesthetized with intravenous sodium thiamylal and intubated with a cuffed endotracheal tube. The right 7 / /"'zL BRACHIOCEPHALIC VEIN femoral artery was cannulated. A Swan-Ganz flow-directed catheter was inserted into the right femoral vein and ad- LIGATED R AXILLARY SUPERIOR VENA CAVA VEIN vanced into the pulmonary artery. A slow infusion of normal saline was administered through the catheter. Addi- FIGURE 1 Preparation of a pouch to collect right duct tional intravenous sodium thiamylal was given as needed lymph. The pouch is open and small veins not previously to maintain active inner eye reflexes with outer eye reflexes are oversewn. When the pouch is closed, a cannula occasionally present. The lungs were inflated maximally with ligated an ambu bag, and 3-5 ml of a 0.5%o aqueous solution of T- will be sewn in place to drain the bloodless right duct lymph. 1824 was injected directly into the right lung via a 20-gauge needle inserted through the chest wall. The dogs were tube received blood for 1 s. I was counted on an Autopermitted to breathe room air spontaneously for the re- Gamma spectrometer (Packard Instrument Co., Downers Grove, Ill.), and 3H was counted on a Tri-Carb liquid scinmainder of the experiment. Right duct lymph was collected in a pouch constructed tillation spectrometer (model 3003, Packard Instrument by ligating the right internal and external jugular, axillary, Co.). Indicator dilution curves were derived for both indiand brachiocephalic veins as described by Leeds et al. (17) cators with recirculation corrected by linear extension of (See Fig. 1). Since lymph from this pouch was often con- the experimental curve on a semilogarithmic plot. Correction taminated with blood, -the pouch was opened and the orifices for the different water contents and pulmonary transit times of small veins still patent were oversewn with 5-0 cardio- of plasma and erythrocytes was made using the formula of vascular silk. The pouch was closed and a cannula sewn into Goresky et al. (19). The lymph collection was discontinued immediately after place. From three to six 20-min collections of bloodless lymph were completed in all dogs except one which appeared completion of the in vivo lung water determination. Each to be in respiratory distress with fulminant pulmonary dog was rapidly exsanguinated while its chest was opened, edema when the lymph collection was begun. In this single and pleural fluid, if present, was removed and measured. A animal, two 15-min lymph samples were completed before 15-ml sample of pleural fluid was stored for later analysis the animal expired. Samples were collected in test tubes con- in a test tube containing lithium heparin anticoagulant. The taining lithium heparin anticoagulant, and the volume of lungs were removed by cutting the main stem bronchi and each sample was measured with a 1-ml tuberculin syringe. the main pulmonary arteries and veins. The larger pulmoPulmonary artery, pulmonary artery wedge, and femoral nary arteries were dissected open, and gross blood was artery pressures were recorded on a multichannel electronic removed. Care was taken to avoid losing edema fluid from photographic recorder (model DR-8, Electronics for Medi- the bronchi. The lungs were weighed. A 300-500-mg section cine Inc., White Plains, N. Y.) using a Statham P23Db of lung was taken from the left upper lobe and also from transducer (Statham Instruments Div., Gould Inc., Oxnard, both the left and right lower lobes. The hemoglobin conCalif.). These pressures were obtained during the first tents of these three samples were used to estimate the intralymph collection period and approximately 10 min before vascular water remaining in the lungs by the method of the end of the final collection. At the time of each pressure Levine and Mellins (20). One lobe from each of eight dogs was prepared for light determination, blood was withdrawn from the pulmonary and femoral arteries and analyzed for Po2, Pco2, and pH and electron microscopical examination by injecting into on a Blood Gas Analyzer (Instrumentation Laboratory, the bronchus a solution of 2.5% glutaraldehyde in SorenInc., Lexington, Mass.). After the final measurement of sen's phosphate buffer at pH 7.6. The lobes were then suspulmonary arterial pressure, 20 ml of pulmonary artery pended in additional fixative. The fixed lung tissue was blood was removed for subsequent analysis and stored in minced, washed in phosphate buffer, osmicated, and emtest tubes containing lithium heparin anticoagulant. The bedded in Araldite (Ladd Research Industries, Inc., Burflow-directed catheter was then withdrawn until a right lington, Vt.). Thin sections were stained with lead citrate and uranyl acetate and were examined with a Siemens ventricular pressure was recorded. Immediately after the right-sided catheter was withdrawn Elmiskop 101 electron microscope (Siemens Corp., Iselin, into the right ventricle, extravascular lung water was mea- N. J.). Tissues from similar regions were processed for sured by the double indicator dilution technique of Chinard light microscopy and stained with hematoxylin and eosin. and Enns (18). II-Albumin was used as an intravascular Muscle, liver, and kidney sections were prepared and exindicator and [3H]water was the extravascular indicator. amined in a similar manner. Pulmonary artery blood sampled about 5 min before The indicators were injected into the right ventricle, and blood samples were collected from the right femoral artery death, pooled right duct lymph, and pleural fluid (if present) into heparinized test tubes on a rotating turntable. Each were centrifuged at 2,000 rpm for 30 min. In 10 experiments, the supernate was removed and analyzed for total 1Abbreviation used in this paper: ANTU, a-naphthyl- protein, sodium, potassium, carbon dioxide, and chloride. Total protein was measured by the biuret reaction, using thiourea.
Lung Lymph Flow in Dogs Given a-Naphthylthiourea
483
a blank to determine the base line for each sample (21). Electrolyte concentrations were determined using automated sequential analysis as described by Skeggs and Hochstrasser (22). The pulmonary artery hematocrit was measured by centrifuging duplicate samples in Wintrobe tubes at 2,000 rpm for 30 min. Postmortem extravascular lung water was measured by weighing both lungs immediately after death and suspending them in absolute alcohol for 24 h and in acetone for another 24 h. The lungs were then dried in an oven at 60°C for 72 h and weighed. Lobes suspended in glutaraldehyde were suspended in acetone for 24 h after small sections had been removed for microscopy. These lobes were then dried and weighed. Postmortem lung water was corrected for estimated intravascular water, and the dry weight of the lung was corrected for estimated residual hemoglobin content. Data were analyzed using statistical methods described in Snedecor and Cochran (23). A coefficient of variation of successive measurements of right duct lymph flow in single experiments was computed. Hemodynamic measurements and protein and electrolyte concentrations in dogs with and without pulmonary edema were compared using a t test for unpaired samples. The rates of lymph flow during the first and last collections in each animal were compared using a t test for paired samples. A linear regression comparing postmortem and in vivo measurements of extravascular lung water, and a linear and a quadratic regression comparing right duct lymph flow and postmortem extravascular lung water were fitted by the method of least squares. Correlation coefficients were calculated, and the conditional error test
discussed by Graybill (24) was used to test for significant improvement of the quadratic over the linear equation.
RESULTS Character of right duct lymph. In all 18 dogs reported in Table I, right duct lymph was clear and had a hematocrit of less than 1%o. Opalescent right duct lymph was obtained from one dog. Since opalescence is an indication of contamination with thoracic duct lymph, data from the dog with opalescent right duct lymph were not used in any subsequent analyses. Right duct lymph and lymphatics were blue in all dogs except two. In these two dogs, lymph became clear blue within 2 min after a second injection of T-1824 directly into the right lung. In the 18 dogs studied, the rate of lymph flow in successive collections of right duct lymph in each dog had a coefficient of variation of 13%. Furthermore, in these 18 experiments, there was no significant difference in the rate of lymph flow between the first and the final collection. Thus, lymph flow in each experiment remained relatively constant during the period of observation. Right duct lymph was successfully collected in 13 of the last 22 consecutive attempts (59%). Measurement of extravascular lung water. Extravascular lung water (Qwl) computed from wet weight,
TABLE I
Summary of Experimental Data* Mean BP
Wt
Qdl
Qwl
idQwl
flow
P1. Eff
kg
g
ml/g
mug
ml/hlg
ml
21 22 20
28.3 30.7 28.0
3.8 4.0 4.3
2.4 2.1 2.3
0.19 0.15 0.23
0 0 0
100 112 120
22 10 12
5 3 6
3.4 3.5 3.6 3.8 4.0 4.6 4.9
2.0 2.3 2.9 2.5 2.5 2.1 3.2 3.2 4.2 4.2 3.5 5.0
0.18 0.11 0.23 0.28 0.32 0.30 0.35 0.25 0.47 0.52 0.50 0.23 0.68 1.22 1.35
0 0 0 0 0 0 0 120 160 60 25 300 55 165 0
113 152 139
3 3 4
132 133
16 16 16 10 18 19
65
-
99
16 23 18 16 18 15 14 16
RDL
Dog no.
Qb
ml/kg
pa
Hct
SaO2
%
%
145 125 180
33 42 52
93 97 96
44 43 34 44 38 43 56 46
-
150 150 130 120 135 165 150 120 195
10 5 5 4 4 6
90 155 110 145 115 90
97 95 95 85 95 93 94 94 90 60 92 80 82 40 42
paw
fa
mm Hg
Controls 1 2 3
Pretreated with ANTU 4 5 6
7 8 9 10 11 12 13 14 15 16 17 18
18 22 16 16 22 21
17 20 17 19 15 16 16 26 20
29.8
37.8 27.0 22.9 33.9 26.7 24.4 31.4 28.0 26.0 23.4 25.6 25.6 44.5 37.0
5.1 6.0 6.9 7.1 7.6 8.0 9.3 10.1
97
226 135 110 107 96 149
-
5 6 -
4
52 51 51 75 52 73 72
* Qdl, dry lung weight; Qwl, extravascular lung water by weighing; idQwl, extravascular lung water by indicators; RDL, right duct lymph; PI. Eff, pleural effusion; Qb, cardiac output by '3'I-albumin; BP, blood pressure; pa, pulmonary artery; paw, pulmonary artery wedge; fa, femoral artery; Hct, hematocrit; SaO2, arterial oxygen saturation.
484
M. Pine, P. Beach, T. Cottrell, M. Scola, and G. Turino
0
5
O Antu -trea ted dogs * Normal dogs
o
0
4 o
3
° 0 O * idQwl * 0.23 + 0.56 Qwl r = 0.90 P
